Tuberculosis-associated mortality and its risk factors in a district of Shanghai, China: a retrospective cohort study

Pulmonary tuberculosis (PTB) causes a considerable number of deaths in China; however, the factors related to mortality are not well known.

To determine mortality among PTB patients and to explore its risk factors in Shanghai, China.

This was a retrospective population-based study. A cohort of PTB patients who initiated treatment in a district of Shanghai from 2004 to 2015 was evaluated. Mortality in PTB patients was studied using the standardised mortality ratio (SMR) and Cox's proportional hazards model.

Of 2741 PTB patients recruited in our study, 394 (14.4%) died during the 12-year follow-up. The summarised SMR was 2.8, and death was most likely to occur during the first months of anti-tuberculosis treatment. Age 60 years (adjusted hazard ratio [aHR] 4.039, P < 0.001), male sex (aHR 1.603, P < 0.001), sputum smear test positivity (aHR 1.945, P < 0.001), multidrug-resistant TB (MDR-TB; aHR 3.502, P = 0.001), diabetes mellitus (aHR 1.422, P = 0.012), chronic obstructive pulmonary disease (aHR 2.505, P < 0.001) and having cancer (aHR 4.319, P < 0.001) were risk factors for PTB mortality.

The overall mortality in PTB patients was higher than that in the general population. MDR-TB and comorbidity were the two leading risk factors for mortality in PTB patients. Early, accurate diagnosis, together with comprehensive management and treatment, can reduce the mortality rate in PTB patients.